Safety and Viability of Totally Tubeless Ambulatory Percutaneous Nephrolithotomy (APCNL) in the Fast Paced World
BM Zeeshan Hameed, Arun Chawla*, Padmaraj Hegde, Avinash Odugoudar, Tirth Vasa
Identifiers and Pagination:Year: 2018
First Page: 14
Last Page: 21
Publisher ID: TOUNJ-11-14
Article History:Received Date: 10/10/2017
Revision Received Date: 10/3/2018
Acceptance Date: 20/3/2018
Electronic publication date: 30/03/2018
Collection year: 2018
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Percutaneous Nephrolithotomy (PCNL) is the gold standard for endoscopic management of large renal stones. Various modifications have been done to bring down the morbidity of this procedure. Ambulatory PCNL (APCNL) defines PCNL as day-care procedure, avoiding overnight hospital stay which is less than 24 hours. Totally tubeless makes faster recovery without the need for double J stent or nephrostomy tubes. This study aimed at exploring the feasibility and safety of APCNL in selective patients. It also aimed at improvising the procedure to facilitate early recovery and discharge of patients within 24 hrs.
Materials ands Methods:
In this study, 12 patients underwent APCNL under general anaesthesia with endotracheal intubation from April 2016 to March 2017. All the procedures were done by a single surgeon. The inclusion criteria were stone size of less than 2cm, without any co-morbidities, Computed Tomography (CT)/Retrograde Pyelogram(RGP) evidence of normal pyelocalyceal anatomy, patient staying within the radius of 15km, well informed patient. All patients underwent totally tubeless PCNL i.e. without nephrostomy, DJ stent and catheter. Skin infiltration was given with 0.25% Bupivacaine. Post operatively analgesia was given on demand (intramuscular Aceclofenac / oral Acetaminophen plus Tramadol). All patients were followed up after 2 weeks.
Twelve patients underwent prone PCNL. All patients had single puncture (10 lower calyx, 2 middle calyx), Amplatz size was less than 30F, size of the stone (1.3cm to 2cm) with a mean size- 1.7cm, saline used around 300ml. But, two patients were discharged after 36hrs and 48hrs due to pain. None of them returned to hospital with haematuria, pain or urinary tract infection.
APCNL is a safe procedure in well informed selective patients. These are the patients with small burden of stone and staying close to the hospital. APCNL reduces the hospital stay, expenses and results in early return to work.